Abstract：Objective To investigate the effects of intravenous thrombolytic therapy and bridging therapy on early neurological deterioration(END) during acute ischemic stroke.Methods The clinical data on 112 patients with acute ischemic stroke who were treated with the intravenous thrombolytic therapy or the bridging therapy within the time window was retrospectively analyzed.These patients were subjected to three days of neurofunctional examinations after admission before they were divided into the END group and the non-END group according to the occurrence of END. The clinical data of the two groups was compared upon admission,including gender,age, hypertension,blood lipids,blood glucose and complications. Observation indexes (P<0.2) were entered into the binary Logistic regression analysis model to identify factors associated with END in case of acute inchemic stroke.Results Among the 112 cases of patients with acute ischemic cerebral infarction, there were 34 cases of END (30.4%).Indexes P<0.2 included gender,the interval between admission and treatment, pre- treatment neurologic function score(NIHSS),blood glucose, total cholesterol, complications with diabetes mellitus,and different therapies.The binary Logistic regression analysis suggested that according to the results of different treatments(OR=6.67,95%CI 1.24-34.93,P=0.025),lipid levels(total cholesterol,HDL and LDL)(OR=1.03,95%CI 1.01-1.06,P=0.034)diabetes control( a history of diabetes and fasting blood glucose levels)(OR=1.16,95%CI 1.03-1.31,P=0.017)were independent predictors of END.Conclusions Different treatments, blood glucose levels and blood lipid metabolic abnormalities in patients with acute ischemic cerebral infarction are factors related to END.
董秋艳, 樊丽娟, 苏慧, 白智华. 急性缺血性脑卒中早期神经功能恶化的影响因素[J]. 武警医学, 2018, 29(1): 21-24.
DONG Qiuyan, FANG Lijuan, SU Hui, and BAI Zhihua. Factors related to early neurological deterioration in acute ischemic stroke. Med. J. Chin. Peop. Armed Poli. Forc., 2018, 29(1): 21-24.
Hennerici M G, Kern R, Szabo K. Non-pharmacological strategies for the treatment of acute ischaemic stroke[J]. Lancet Neurol,2013,12(6):572-584.
[3]
Berkhemer O A, Fransen P S, Beumer D, et al . A randomized trial of intraarterial treatment for acute ischemic stroke[J]. N Engl J Med,2015,372(1):11-20.
[4]
Goyal M, Demchuk A M, Menon B K, et al . Randomized assessment of rapid endovascular treatment of ischemic stroke[J]. N Engl J Med,2015,372(11):1019-1030.
[5]
Campbell B C, Mitchell P J, Kleinig T J, et al . Endovascular therapy for ischemic stroke with perfusion-imaging selection[J]. N Engl J Med,2015,372(11):1009-1018.
[6]
Saver J L, Goyal M, Diener H C. Stent-Retriever Thrombectomy for Stroke[J]. N Engl J Med,2015,373(11):1077.
[7]
Jovin T G, Chamorro A, Cobo E, et al . Thrombectomy within 8 hours after symptom onset in ischemic stroke[J]. N Engl J Med,2015,372(24):2296-2306.
[8]
Nagakane Y, Naritomi H, Oe H, et al . Neurological and MRI findings as predictors of progressive-type lacunar infarction[J]. Eur Neurol,2008,60(3):137-141.
[9]
Helleberg B H, Ellekjaer H, Rohweder G, et al . Mechanisms, predictors and clinical impact of early neurological deterioration: the protocol of the Trondheim early neurological deterioration study[J]. BMC Neurol,2014,14:201.
[10]
Nacu A, Bringeland G H, Khanevski A, et al . Early neurological worsening in acute ischaemic stroke patients[J]. Acta Neurol Scand,2016,133(1):25-29.
[11]
Nannoni S, Del B A, Palumbo V, et al . Predictors of progression in patients presenting with minor subcortical stroke[J]. Acta Neurol Scand,2015,132(5):304-309.
[12]
Chung J W, Kim N, Kang J, et al . Blood pressure variability and the development of early neurological deterioration following acute ischemic stroke[J]. J Hypertens,2015,33(10):2099-2106.
[13]
Li H, Qiu W, Hu B, et al . Ischemic volumes and early neurologic deterioration in acute brainstem infarctions with hemoglobin A1c[J]. Eur Neurol,2013,70(3-4):225-232.
[14]
Kjaergaard A D, Johansen J S, Bojesen S E, et al . Elevated plasma YKL-40, lipids and lipoproteins, and ischemic vascular disease in the general population[J]. Stroke,2015,46(2):329-335.
[15]
Stone N J, Robinson J G, Lichtenstein A H, et al . 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines[J]. J Am Coll Cardiol,2014,63(25 Pt B):2889-2934.
[16]
Yuan B B, Luo G G, Gao J X, et al . Variance of Serum Lipid Levels in Stroke Subtypes[J]. Clin Lab,2015,61(10):1509-1514.
[17]
Pikija S, Trkulja V, Juvan L, et al . Higher on-admission serum triglycerides predict less severe disability and lower all-cause mortality after acute ischemic stroke[J]. J Stroke Cerebrovasc Dis,2013,22(7):e15-e24.
[18]
Tanaka R, Ueno Y, Miyamoto N, et al . Impact of diabetes and prediabetes on the short-term prognosis in patients with acute ischemic stroke[J]. J Neurol Sci,2013,332(1-2):45-50.
[19]
Tureyen K, Bowen K, Liang J, et al . Exacerbated brain damage, edema and inflammation in type-2 diabetic mice subjected to focal ischemia[J]. J Neurochem,2011,116(4):499-507.
[20]
Yang H, Ma S, Liu Y, et al . Poor outcome of experimental ischemic stroke in type 2 diabetic rats: impaired circulating endothelial progenitor cells mobilization[J]. J Stroke Cerebrovasc Dis,2015,24(5):980-987.
[21]
Mishiro K, Imai T, Sugitani S, et al . Diabetes mellitus aggravates hemorrhagic transformation after ischemic stroke via mitochondrial defects leading to endothelial apoptosis[J]. PLoS One,2014,9(8):e103818.
[22]
Ozkul A, Ayhan M, Akyol A, et al . The effect of insulin resistance on inflammatory response and oxidative stress in acute cerebral ischemia[J]. Neuro Endocrinol Lett,2013,34(1):52-57.
[23]
Liu A, Carmichael K A, Schallom M E, et al . Detecting and Managing Diabetes Mellitus and Prediabetes in Patients With Acute Stroke[J]. Diabetes Educ,2015,41(5):592-598.
[24]
Kim J P, Kim S J, Lee J J, et al . Diffusion-Perfusion Mismatch in Single Subcortical Infarction: A Predictor of Early Neurological Deterioration and Poor Functional Outcome[J]. Eur Neurol,2015,73(5-6):353-359.
[25]
Alexandrov A V, Grotta J C. Arterial reocclusion in stroke patients treated with intravenous tissue plasminogen activator[J]. Neurology,2002,59(6):862-867.
[26]
Cohen J E, Gomori J M, Rajz G, et al . Extracranial carotid artery stenting followed by intracranial stent-based thrombectomy for acute tandem occlusive disease[J]. J Neurointerv Surg,2015,7(6):412-417.
2018, Vol. 29 
